Mississippi is also ranked at the bottom of the states in America’s Health Rankings in the 2013 evaluation, the most recent available, by the United Health Foundation. Mississippi’s 50th ranking is based on high rates of physical inactivity, obesity, diabetes; low immunization rates among adolescents; a high infant mortality rate; and a high prevalence of low birthweights. Mississippi does have some public health positives, including a low prevalence of binge drinking, high immunization rates for children, and little disparity in health status by level of education completed.

If you’re more interested in comparing counties within Mississippi, use theses health rankings from the Robert Wood Johnson Foundation and the Population Health Institute at the University of Wisconsin.

Mississippi and the Affordable Care Act

At the federal level, both Sens. Thad Cochran and Roger Wicker voted against the ACA in 2010. Cochran and Wicker are both Republicans and remain in office. Cochran is running for re-election in November, facing former Rep. Travis Childers.

Breaking with a strong majority of their party, two Democratic Representatives from Mississippi voted against the ACA in 2010, as did Rep. Gene Taylor. Rep. Bennie Thompson, a Democrat, was the sole Mississippi vote for the ACA. Republicans now hold three of Mississippi’s four seats in the U.S. House.

At the state level, State Commissioner of Insurance Mike Chaney clashed with two governors in an effort to establish a state-run insurance exchange. Chaney, current Gov. Phil Bryant, and former Gov. Haley Barbour are all Republicans and on record as opposing the Affordable Care Act. However, Chaney insisted that a state-run exchange was a better option for the state.

Chaney went so far as notifying the U.S. Department of Health and Human Services (HHS) that Mississippi intended to implement a state-run exchange. However, Bryant told HHS that Chaney didn’t have the authority to make that decision, and HHS rejected Mississippi’s exchange blueprint.

Mississippi defaulted to the federally facilitated exchange, and the state also declined to expand Medicaid.

How did the ACA help Mississippi?

The uninsured rate in Mississippi decreased 1.8 percentage points after the ACA’s individual mandate took effect. In 2013, the rate was 22.4 percent. As of mid-2014, the rate was 20.6 percent.

Mississippi’s uninsured rate remains well above the national average of 13.4 percent. It’s also above the 16.5 percent average seen among other states that have not embraced the ACA; i.e., those that have not implemented a state-run marketplace or expanded Medicaid, or have only implemented one of those measures.

Mississippi enrollment in QHPs

Ninety-four percent of those selecting QHPs qualified for financial assistance, and the average premium after tax subsidies was $23 a month.

PwC, a consulting and auditing organization, analyzed state insurance filings and estimated that the average premium cost in Mississippi will increase 3.8 percent in 2015. However, only limited information was available for the analysis.

Medicaid and CHIP eligibility in Mississippi

Mississippi did not expand Medicaid through the Affordable Care Act. The state’s decision leaves 203,000 Mississippi adults ineligible for Medicaid and an additional 138,000 in the coverage gap according to the Kaiser Family Foundation.

Without Medicaid expansion, non-elderly, non-disabled adults without children are not eligible for Medicaid. Adults with dependent children qualify for Medicaid only if the family’s income is 29 percent or less of the federal poverty level (FPL). Medicaid eligibility for Mississippi children varies by age and ranges from 133 percent to 194 percent of FPL.

Children in Mississippi up to age 19 qualify for the Children’s Health Insurance Program if not eligible for Medicaid and the family income level is 209 percent or less of FPL.

Based on existing eligibility criteria, 13,779 Mississippians qualified for Medicaid or CHIP during the 2014 ACA open enrollment period.

Enrollment for Medicaid and CHIP is open throughout the year. Visit the Mississippi Division of Medicaid to learn how to apply for Medicaid or CHIP.

CO-OPs operated in 23 states in 2014, and three are expanding into neighboring states in 2015. See where CO-OPs were launched.

No CO-OP was created in Mississippi.

Does Mississippi have a high-risk pool?

Before the ACA’s reforms to the individual health insurance market, eligibility for private coverage was contingent on medical history. People with pre-existing conditions were often unable to purchase private plans, or could only buy policies that excluded their pre-existing conditions.

Now that the ACA has brought guaranteed issue coverage to the private individual market, high risk pools are largely obsolete. But the Association has remained operational, and has a message on its homepage reassuring members that the ACA is not bringing any immediate changes to their existing coverage.